Pneumonia最新文献

{"title":"Evaluation of PSI, CURB-65, and CRB-65 as prognostic tools in hospitalized immunocompetent patients with pneumonia: real-world outcomes from internal medicine wards.","authors":"Alon Pomerantz, Adar Yaacov, Adam Goldman, Yonatan Moshkovits, Asaf Zlotnik, Ofir Deri, Liran Levy","doi":"10.1186/s41479-025-00191-x","DOIUrl":"10.1186/s41479-025-00191-x","url":null,"abstract":"<p><p>BACKGROUND: Pneumonia remains a leading cause of morbidity and mortality globally, necessitating reliable clinical prediction tools to guide medical management decisions. The Pneumonia Severity Index (PSI), CURB-65, and CRB-65 are clinical scoring tools used to assess the severity of community-acquired pneumonia (CAP), aiding in risk stratification and guiding decisions on hospitalization, level of care and prognosis. Comparative data on their utility, specifically in immunocompetent patients hospitalized in internal medicine wards, are limited. This study aimed to evaluate the predictive capabilities of these scoring tools for mortality and intensive care unit (ICU) transfers in a large cohort of hospitalized patients. METHODS: We conducted a retrospective, single-center cohort study including 12,670 immunocompetent patients hospitalized with pneumonia in the internal medicine division. PSI, CURB-65, and CRB-65 performance was compared across multiple outcomes, including in-hospital mortality, 30-, 60-, 90-day mortality, and ICU transfer from ward. Subgroup analyses were performed for key comorbidities (chronic obstructive pulmonary disease [COPD], congestive heart failure [CHF], diabetes, chronic kidney disease [CKD] and hypertension). RESULTS: PSI consistently demonstrated significantly superior discrimination between survivors and non-survivors across all mortality outcomes with AUC range of 0.73–0.75 (p < 0.001, FDR-corrected). In the subgroup analysis by comorbidities, PSI was significantly superior to the other scoring systems only in diabetes patients in 60 and 90-day mortality (AUC = 0.70–0.71). CURB-65 performed comparably to PSI in most of the cases and was superior to CRB-65 only in diabetes and hypertension patients. When predicting ICU transfer during hospitalization, there were no significant differences between the scoring tools, and all demonstrated low predictive capability. CONCLUSION: The PSI demonstrates superior discriminative ability in immunocompetent patients hospitalized with pneumonia. However, its greater complexity should be considered when evaluating its practicality for routine use. </p>","PeriodicalId":45120,"journal":{"name":"Pneumonia","volume":"18 1","pages":"3"},"PeriodicalIF":3.8,"publicationDate":"2026-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12832007/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146044065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic BioFire® FilmArray® Pneumonia Panel Plus versus standard microbial culture in bronchiectasis exacerbations.","authors":"Patricia Oscanoa-Huamán, Leticia Bueno, Roberto Cabrera, Andrea Palomeque, Albert Gabarrús, Nil Vázquez, Alba Soler-Comas, Ruben López-Aladid, Victoria Alcaraz-Serrano, Nona Rovira-Ribalta, Jordi Vila, Laia Fernández-Barat, Antoni Torres","doi":"10.1186/s41479-025-00190-y","DOIUrl":"10.1186/s41479-025-00190-y","url":null,"abstract":"<p><strong>Background: </strong>The diagnostic performance of the BioFire® FilmArray® Pneumonia Panel Plus (FAPP) compared to standard microbial culture (SMC) during bronchiectasis (BE) exacerbations is unknown.</p><p><strong>Objective: </strong>To compare the microbiological diagnostic performance between FAPP and SMC during BE exacerbations.</p><p><strong>Study design and methods: </strong>A prospective observational study was conducted in adults with a BE exacerbation at the Hospital Clinic of Barcelona (Spain) June 2020 to April 2022. All sputum samples underwent processing using both the FAPP and SMC (n = 109) but we focused in good quality samples (n = 73).</p><p><strong>Results: </strong>The FAPP detected pathogens in a higher percentage (n = 64, 88%) compared to SMC (n = 41, 56%). This increase was higher in samples from patients receiving empiric antibiotic treatment (n = 24, 89% and n = 10, 37%, for FAPP and SMC, respectively). The FAPP identified in 29 sputum (40%) more than one microorganism, while by SMC were all monomicrobial (n = 73, 100%). In 93 out of 109 BE exacerbations (85%), clinicians used the FAPP results for treatment decisions. According to the pathogen found by FAPP, immediate change of empiric treatment occurred in 15 out of 38 patients (40%) receiving empiric antimicrobial at time of exacerbation. Early treatment adequacy likely contributed to the low rate of treatment modifications observed by day 5 of exacerbation when the overall rate of treatment changes was low (8%) and treatment failure was noted in only 2% of the total population.</p><p><strong>Conclusion: </strong>The FAPP demonstrated significantly higher microbiological diagnostic performance compared to SMC, regardless of prior antibiotic exposure. Improved pathogen detection using FAPP enabled more accurate initial antimicrobial therapy, which was associated with low rates of treatment failure.</p>","PeriodicalId":45120,"journal":{"name":"Pneumonia","volume":"18 1","pages":"1"},"PeriodicalIF":6.2,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12766951/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145901184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Invasive pulmonary aspergillosis in the ICU: the corticosteroid link.","authors":"Cynthia Terrones-Campos, Antonio Gallardo-Pizarro, Ana Martinez-Urrea, Ainhoa Castiella, Andrea Vergara, Azucena Gonzalez, Natalia Egri, Carolina Garcia-Vidal","doi":"10.1186/s41479-025-00189-5","DOIUrl":"10.1186/s41479-025-00189-5","url":null,"abstract":"<p><p>Invasive pulmonary aspergillosis (IPA) is a life-threatening fungal infection traditionally associated with severely immunocompromised hosts, particularly those with hematologic malignancies. However, its epidemiological profile has shifted in recent years, with a rising incidence among critically ill patients in intensive care units (ICUs), many of whom lack classical risk factors. This change is driven by increased use of corticosteroids and immunomodulatory therapies, the growing prevalence of chronic lung disease, and severe viral pneumonias such as influenza and COVID-19. In these patients, airway epithelial injury, immune dysregulation, and mechanical ventilation facilitate fungal invasion even in the absence of profound immunosuppression. Corticosteroids play a central role in IPA pathogenesis. While they limit hyperinflammation, they simultaneously impair fungal clearance by suppressing NF-κB signaling, downregulating TNF-α production, and promoting IL-10 secretion, resulting in a Th2-skewed immune profile. Neutrophil recruitment persists but becomes dysregulated, contributing to tissue injury rather than effective pathogen elimination. Corticosteroids may also directly enhance Aspergillus growth, further compounding risk. Diagnosis of IPA in ICU patients remain challenging because radiological hallmarks such as the halo sign are uncommon, and distinguishing colonization from invasive disease is difficult. Serum and bronchoalveolar lavage galactomannan, β-D-glucan assays, and PCR can improve early detection, but no single test is definitive in this heterogeneous population. As much as possible, high-quality lower respiratory tract samples should be obtained. Furthermore, effective treatment requires not only timely diagnosis, but also careful selection of antifungal taking into consideration pharmacologic challenges of ICU patients and pharmacodynamics of antifungals. Recognition of high-risk patients such as those receiving corticosteroids, those with chronic lung disease, severe viral pneumonia, or requiring invasive ventilation is critical to improve outcomes. Mortality in this group can exceed that of neutropenic patients, underscoring the need for heightened clinical suspicion and timely antifungal therapy. A deeper understanding of the immunopathogenesis of IPA in non-neutropenic patients, particularly the dual effects of corticosteroids on inflammation and host defense, may inform risk stratification and guide earlier intervention. Enhanced surveillance, prompt diagnostic workup, and judicious use of immunomodulatory therapy represent key strategies to mitigate the rising burden of this devastating infection in ICU settings.</p>","PeriodicalId":45120,"journal":{"name":"Pneumonia","volume":"18 1","pages":"2"},"PeriodicalIF":3.8,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12766946/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145901209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influence of area-level social vulnerability on all-cause pneumonia, all-cause acute otitis media, and invasive pneumococcal disease incidence among Medicaid-enrolled children.","authors":"Salini Mohanty, Michael Barna, Kelsie Cassell, Nicole Cossrow, Peter C Fiduccia, Esther Smith-Howell, Valina C McGuinn, Alyssa Evans, Aparna Keshaviah, Priya Shanmugam, Saumya Chatrath, Constance Delannoy, Kristen A Feemster, Lisa Weissburg, Jelena Zurovac","doi":"10.1186/s41479-025-00186-8","DOIUrl":"10.1186/s41479-025-00186-8","url":null,"abstract":"<p><p>BACKGROUND: The incidence of pneumococcal disease differs based on demographic and clinical factors, yet the impact of area-level social determinants of health, particularly for children, remains less understood. We characterized the relationship between individual and area-level social vulnerability and incidence of all-cause pneumonia (ACP), acute otitis media (AOM), and invasive pneumococcal disease (IPD) among children across the US. METHODS: Using a retrospective observational design, we measured disease incidence among children 18 years and younger covered by Medicaid, using claims from 2017 through 2019. We measured social vulnerability using quintiles of the county-level Minority Health Social Vulnerability Index (MHSVI) and its six subthemes (Socioeconomic Status; Household Composition and Disability; Minority Status and Language; Housing Type and Transportation; Health Care Infrastructure and Access; Medical Vulnerability). After calculating county-level ACP, AOM, and IPD incidence rates overall and among counties in each MHSVI quintile, we used Poisson regression to characterize the relationship between social vulnerability and disease incidence, controlling for confounding by child demographic characteristics. We analyzed this relationship overall and within age and race/ethnicity subgroups. RESULTS: Across 38.1 million children, ACP, AOM, and IPD incidence rates were 1,767, 16,486, and 3.3 per 100,000 person-years, respectively. ACP and AOM incidence rates were lower among children in the most versus least socially vulnerable counties (unadjusted incidence rate ratio = 0.89 and 0.75, respectively; both P < 0.0001); differences were attenuated but remained statistically significant after adjusting for child demographics. The direction of the relationship between ACP and AOM incidence and vulnerability varied by type of vulnerability: incidence was lower in counties that were most (versus least) vulnerable based on Minority Status and Language or Housing Type and Transportation, but higher in those most vulnerable based on Household Characteristics or Disability and Medical Vulnerability. Differences in IPD incidence between the most versus least vulnerable counties were generally non-significant, due to the low overall incidence. CONCLUSIONS: Incidence of AOM and ACP in children varies significantly by demographic characteristics and county-level medical and non-medical social determinants of health. Social vulnerability may be useful to identify factors associated with disparities in pneumococcal disease and develop targeted interventions to reduce them. </p>","PeriodicalId":45120,"journal":{"name":"Pneumonia","volume":"17 1","pages":"35"},"PeriodicalIF":3.8,"publicationDate":"2025-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12739848/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145828838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Investigating risk factors for methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa in community acquired pneumonia: a model for using only electronic data capture.","authors":"Philip Logan Whitfield, Kristen Wendler, Rachel Gabor, Mark Ridder","doi":"10.1186/s41479-025-00188-6","DOIUrl":"10.1186/s41479-025-00188-6","url":null,"abstract":"<p><strong>Background: </strong>The 2019 American Thoracic Society and Infectious Diseases Society of America community acquired pneumonia guidelines recommend empiric coverage of methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa based on previous respiratory isolation, recent IV antibiotic use, and locally validated risk factors. This study aims to describe how local risk factors may be determined efficiently using data retrieved electronically.</p><p><strong>Methods: </strong>This retrospective cohort study focused on the time period May 13, 2020, through June 30, 2024. Consecutive adults admitted to one of five acute care facilities with confirmed community-acquired pneumonia were included. Community-acquired pneumonia was defined as the presence of one or more pneumonia diagnosis codes and an order for a respiratory culture or an antimicrobial with the indication of pneumonia or sepsis, 24 h before or within 48 h after the date and time of admission. Patients were excluded if they had a diagnosis code for hospital-acquired or ventilator-associated pneumonia, any subsequent admission in the study period, or if they had a previous respiratory culture positive for methicillin-resistant Staphylococcus aureus or Pseudomonas aeruginosa within a year of admission. The causative pathogen and the presence or absence of evaluated risk factors were electronically abstracted from billing data and health records. Serial quality assessments of electronic data were performed to improve accuracy until a well validated population was determined.</p><p><strong>Results: </strong>There were 4,558 unique patients included. Methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa rates were 0.6% and 0.7%, respectively. Only age was inversely associated with risk of methicillin-resistant Staphylococcus aureus (OR = 0.86, 95% CI: 0.76-0.98). No significant risk factors for Pseudomonas aeruginosa were found.</p><p><strong>Conclusions: </strong>In rural or otherwise resource limited healthcare settings, risk factors for methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa community-acquired pneumonia may be determined using only electronic data capture and the methodology described in this article.</p>","PeriodicalId":45120,"journal":{"name":"Pneumonia","volume":"17 1","pages":"32"},"PeriodicalIF":6.2,"publicationDate":"2025-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12739841/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145828775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pneumocystis pneumonia in older non-HIV-infected patients: a French, multicentre, retrospective, cohort study.","authors":"Adrien Barraud, Romaric Larcher, Gaëtan Gavazzi, Arthur Fourmy, Renaud Verdon, Sophie Ancellin, Albert Sotto, Valéry Antoine, Alain Putot, Paule Letertre-Gibert, Emmanuel Forestier, Claire Roubaud-Baudron, Matthieu Coulongeat, Thibaut Fraisse","doi":"10.1186/s41479-025-00187-7","DOIUrl":"10.1186/s41479-025-00187-7","url":null,"abstract":"<p><p>BACKGROUND: Pneumocystis pneumonia (PCP) is well-described in younger and HIV-infected populations, but limited data are available for older non-HIV-infected patients. The aim was to describe the clinical characteristics, management and outcomes of PCP in older non-HIV-infected patients and to identify factors associated with in-hospital mortality. METHODS: This multicentre, retrospective, cohort study included patients aged ≥ 75 years, hospitalised for non-HIV-related PCP in 12 French university hospitals between January, 2010 and December, 2021. PCP diagnosis was confirmed by PCR or microscopy. Data on demographics, comorbidities, clinical features, management and outcomes were collected. Factors associated with in-hospital mortality were identified by univariate and multivariate analysis. RESULTS: A total of 175 patients were screened and 162 were included (median age: 79 years, 57.4% male). Most patients had haematological malignancies (35.8%) or solid tumours (34.5%) and were treated with long-term corticosteroids (60%). Respiratory symptoms (87.6%) and bilateral interstitial lung involvement were common. Diagnosis was based on PCR of bronchoalveolar lavage (66.4%) or sputum samples (32.3%). In-hospital mortality was 27.8%. CRP level > 110 mg/L (HR = 2.55 [95%CI: 1.35–4.83], p = 0.004) and initiation of corticosteroids for PCP treatment (HR = 1.89 [95%CI: 1.03–3.44], p = 0.039) were associated with mortality. Patients with higher oxygen saturation at admission (HR = 0.94 [95%CI: 0.91–0.97], p < 0.001) had a lower risk of death. CONCLUSION: PCP in older non-HIV-infected patients has a high mortality rate, particularly in the presence of elevated CRP, hypoxaemia or corticosteroid use. Future research should focus on identifying subgroups potentially benefiting from corticosteroids and exploring safe therapeutic options for this vulnerable population. </p>","PeriodicalId":45120,"journal":{"name":"Pneumonia","volume":"17 1","pages":"34"},"PeriodicalIF":3.8,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12679795/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145679081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corticosteroids and hospital-acquired pneumonia.","authors":"Lucia Alessandra Pasqua, Catia Cilloniz, Antoni Torres","doi":"10.1186/s41479-025-00185-9","DOIUrl":"10.1186/s41479-025-00185-9","url":null,"abstract":"<p><p>Hospital-acquired pneumonia (HAP) is a serious infection with high mortality rates, especially in critically ill patients. The role of corticosteroids as adjunctive therapy in this population is debated. These agents have anti-inflammatory and immunomodulatory properties, which have the potential to reduce pulmonary inflammation and improve oxygenation. However, the risk of secondary infections and metabolic complications that their use may entail is a matter for concern, given their impact on patients’ outcome. In this review, we discuss the current scientific evidence on the use of corticosteroids as adjunctive therapy for patients with HAP and VAP, its implications for patients’ clinical outcomes, and the possible effects. Corticosteroids are not recommended as standard therapy for HAP/VAP but may be beneficial in selected subgroups of patients.</p>","PeriodicalId":45120,"journal":{"name":"Pneumonia","volume":"17 1","pages":"33"},"PeriodicalIF":3.8,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12679776/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145679145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immunosuppressed patients with COVID-19 pneumonia in ICU: clinical characteristics and factors influencing outcomes.","authors":"Flavia Galli, Edoardo Forin, Ana Motos, Francisco José Molina Saldarriaga, Albert Gabarrus, Joan Canseco, Laia Fernandez-Barat, Enric Barbeta, Davide Calabretta, Adrian Ceccato, Jesus F Bermejo-Martin, Ricard Ferrer, Jordi Riera, Oscar Penuelas, Jose Angel Lorente, David de Gonzalo-Calvo, Rosario Menendez, Jessica Gonzalez, Andrea Palomeque, Alba Soler-Comas, Rosario Amaya-Villar, Jose Manuel Anon, Ana Balan Marino, Carme Barbera, Jose Barberan, Aaron Blandino Ortiz, Elena Bustamante-Munguira, Jesus Caballero, Maria Luisa Canton-Bulnes, Cristina Carbajales Perez, Nieves Carbonell, Mercedes Catalan-Gonzalez, Raul de Frutos, Nieves Franco, Cristobal Galban, Ana Lopez Lago, Victor D Gumucio-Sanguino, Maria Del Carmen de la Torre, Emilio Diaz, Angel Estella, Elena Gallego Curto, Jose Luis Garcia-Garmendia, Jose Manuel Gomez, Arturo Huerta, Ruth Noemi Jorge Garcia, Ana Loza-Vazquez, Judith Marin-Corral, Maria Cruz Martin Delgado, Amalia Martinez de la Gandara, Ignacio Martinez Varela, Juan Lopez Messa, Guillermo M Albaiceta, Maria Teresa Nieto, Mariana Andrea Novo, Yhivian Penasco, Felipe Perez-Garcia, Juan Carlos Pozo-Laderas, Pilar Ricart, Victor Sagredo, Angel Sanchez-Miralles, Susana Sancho Chinesta, Ferran Roche-Campo, Lorenzo Socias, Jordi Sole-Violan, Fernando Suarez-Sipmann, Luis Tamayo Lomas, Jose Trenado, Alejandro Ubeda, Luis Jorge Valdivia, Pablo Vidal, Maria Victoria Boado, Alejandro Rodriguez, Miquel Ferrer, Ferran Barbe, Antoni Torres","doi":"10.1186/s41479-025-00181-z","DOIUrl":"10.1186/s41479-025-00181-z","url":null,"abstract":"<p><strong>Introduction: </strong>COVID-19 severely impacted global health, especially older adults and those with comorbidities. Immunosuppressed patients are at high risk for severe outcomes, yet studies yield conflicting mortality rates for this group. This study examines the clinical characteristics and outcomes of immunosuppressed (IS) versus non-immunosuppressed (nIS) patients with COVID-19 in ICUs.</p><p><strong>Methods: </strong>A multicenter, observational case-control study included 5,824 ICU patients with COVID-19 from the CIBERESUCICOVID study. Patients were categorized as IS or nIS based on history of transplantation, HIV, active neoplasia, and use of immunosuppressive drugs or corticosteroids. The primary outcome was 90-day mortality; secondary outcomes included in-hospital, 15-day, 30-day and 1-year mortality, ICU-free days, ventilator-free days, and hospital length of stay. Subgroup analyses examined vaccination status and tocilizumab treatment. Propensity score (PS) matching was used to obtain balance among the baseline variables in the two groups.</p><p><strong>Results: </strong>IS patients (n = 689, 11.8%) were older, had more comorbidities, and higher APACHE-II scores. After PS matching, IS patients had higher 90-day mortality (39 vs. 33%; HR 1.30, 95% CI 1.04 to 1.62), as well as higher in-hospital (37 vs. 29%; sHR 1.35, 95% CI 1.08 to 1.69), 30-day (28 vs 23%; HR 1.31, 95% CI 1.01 to 1.69) and 1-year mortality (45 vs. 38%; HR 1.26, 95% CI 1.02 to 1.57). Among IS patients, transplant recipients had significantly higher 90-day mortality after matching (HR 4.45, 95% CI 1.46 to 13.58). Vaccinated IS patients showed higher mortality than vaccinated nIS patients, though differences were not significant after PS matching. Tocilizumab treatment in IS patients was associated with reduced mortality; multivariable analysis confirmed a significant decrease in in-hospital mortality (sHR 0.56, 95% CI 0.42 to 0.76).</p><p><strong>Conclusion: </strong>Critical immunosuppressed patients with COVID-19 have higher mortality, particularly transplant recipients. Tocilizumab shows potential benefits for IS patients. These findings highlight the need for tailored therapeutic strategies for immunosuppressed individuals with severe COVID-19. Further research is needed to confirm these results in the current clinical context.</p>","PeriodicalId":45120,"journal":{"name":"Pneumonia","volume":"17 1","pages":"30"},"PeriodicalIF":6.2,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12645730/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145597915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Individualized treatment rule for early steroid use in hospitalized patients with community acquired pneumonia: a cohort study.","authors":"Yewande E Odeyemi, Allison M LeMahieu, Erin F Barreto, Hemang Yadav, Ognjen Gajic, Phillip Schulte","doi":"10.1186/s41479-025-00182-y","DOIUrl":"10.1186/s41479-025-00182-y","url":null,"abstract":"<p><p>BACKGROUND: Current evidence on an optimal patient selection strategy for adjunctive steroids to curb excessive inflammation in community acquired pneumonia (CAP) is limited. An individualized treatment rule (ITR) customizes treatment recommendations based on individual patient characteristics. The objective of this study was to develop an ITR for early steroid use in hospitalized patients with CAP. METHODS: Using a single center cohort of hospitalized patients with CAP from 2009 to 2019, we developed a single decision ITR to initiate or not initiate steroids early (within 24 h) after admission. The primary outcome of interest was hospital-free days measured at 28 days. Regression-based learning with LASSO selected a model estimating expected outcomes of potential intervention with steroids individualized to predictors. The optimal ITR was compared to other treatment rules including as observed in the data. RESULTS: A total of 4379 patients were included in this cohort with 1412 (32%) patients receiving steroids within 24 h of hospital admission. Compared to observed practice, an optimal ITR was associated with increased hospital-free days (mean rate [95% confidence interval (CI)]: 21.74 [21.52, 21.95] versus 22.31 [22.11, 22.51]). The optimal ITR for the secondary outcomes including ventilator-free days, mortality and need for advanced respiratory failure support and/or mortality revealed better estimates compared to what was observed in the data. However, there was a lack of consistent performance when applying the advanced respiratory failure and/or mortality (a secondary outcome) ITR to other outcomes (inconsistency of results across models). CONCLUSION: An ITR for early steroid use in hospitalized patients with CAP did not consistently improve clinical outcomes. </p>","PeriodicalId":45120,"journal":{"name":"Pneumonia","volume":"17 1","pages":"29"},"PeriodicalIF":3.8,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12645675/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145597977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pneumococcal carriage and disease in adults hospitalised with community-acquired pneumonia in Mongolia: prospective pneumonia surveillance program (2019-2022).","authors":"Tuya Mungun, Munkhchuluun Ulziibayar, Cattram D Nguyen, Purevsuren Batsaikhan, Bujinlkham Suuri, Dashtseren Luvsantseren, Dorj Narangerel, Bilegtsaikhan Tsolmon, Lien Anh Ha Do, Darren Suryawijaya Ong, Belinda D Ortika, Casey L Pell, Laura K Boelsen, Ashleigh C Wee-Hee, Leena Spry, Jason Hinds, Michael W Pride, Eileen M Dunne, Bradford D Gessner, E Kim Mulholland, Catherine Satzke, Claire von Mollendorf","doi":"10.1186/s41479-025-00184-w","DOIUrl":"10.1186/s41479-025-00184-w","url":null,"abstract":"<p><strong>Background: </strong>Streptococcus pneumoniae is an important cause of pneumonia in older adults, however, serotyping and indirect impact information from low and middle-income countries is lacking. Mongolia has a childhood 13-valent pneumococcal conjugate vaccine (PCV13) program, but no adult pneumococcal vaccination program. We describe pneumococcal carriage rates, disease and serotype distribution among adults hospitalised with pneumonia, and explore changes over the COVID-19 pandemic period.</p><p><strong>Methods: </strong>Adults (≥ 18 years) hospitalised with clinical pneumonia were enrolled over 3 years (March 2019-February 2022) into a prospective pneumonia surveillance program. Nasopharyngeal swabs were tested to detect pneumococci using lytA qPCR and molecular serotyping by DNA microarray and metagenomics. Pneumococcal pneumonia was identified using serotype-specific urinary antigen detection and BinaxNOW^® assays. Pneumococcal carriage and pneumonia prevalence were assessed over the COVID-19 period with log-binomial regression used to estimate prevalence and adjusted prevalence ratios (pre- versus early- and late-COVID-19 periods).</p><p><strong>Results: </strong>Of 3,178 pneumonia cases, S. pneumoniae was identified in 12.1% (333/2,759) of swabs and 8.6% (253/2,925) of urine samples. PCV13 serotype carriage prevalence was 3.1% (82/2,663) and non-PCV13 serotype carriage prevalence 5.7% (152/2,663). In the late-COVID-19 period, pneumococcal carriage prevalence was reduced by 66% (aPR 0.34, 95%CI 0.25-0.46) and pneumococcal pneumonia by 82% (aPR 0.18, 95%CI 0.12-0.27) compared with the pre-COVID-19 transmission period.</p><p><strong>Conclusion: </strong>Despite paediatric vaccination with high coverage, we identified some residual PCV13 serotypes with predominance of non-PCV13 serotypes carried and causing disease in adults. Direct adult vaccination which targets these serotypes will potentially reduce disease in adults in Mongolia.</p>","PeriodicalId":45120,"journal":{"name":"Pneumonia","volume":"17 1","pages":"27"},"PeriodicalIF":6.2,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12645769/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145597900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}